Why I realised the importance of the psychosocial in medicine...

Women of the world by robynejay

Students often don't seem to understand why the social sciences are important to understanding health and the way that we organise health services. The relevance has always seemed rather obvious to me but then I have to wonder if this doesn't have something to do with my own personal circumstances. Or else wouldn't all medical students think the same? So a few facts about me, the person who entered medical school in Belfast aged 18:

• I grew up on a small farm in Northern Ireland
• I'm the eldest of 4 children
• My maternal grandmother died in childbirth
• My mother's aunt started living with us when I was 6. My mother cared for her for 25 years until she died aged 103
• My family had a great interest in politics and my father was elected as a local councillor
• My father died suddenly when I was 14
• The family income fell as a result of my father's death but we were no longer entitled to free school meals
• I took a GCSE in sociology when at school. My coursework project considered why although the school was predominantly female, we only made up 1/3 of the a-level physics class.

I don't usually write about personal things here and there is a lot more I could say about what might have shaped my identity as a doctor. I am left wondering if many students don't question the structures and practice of medicine (insights that can be gained from the social sciences) because nothing in their own personal lives has sensitised them to the way that we organise society. 

If this is so, what can we do about it? If I am wrong, then what can we do about it? Either way we need to do something to shake things up.

How education could learn from games.....

Many thanks to Dom Rodwell, a first year medical student at UEA for sending me the link to this. There are lots of comments here. But how do you think any of the lessons here might be relevant to medical education?

Clinical learning in the open: the strengths of social media.

Image: Open by Justin Marty

Last night I had quite a few learning episodes on Twitter. It started with Christian Assad's post about how Twitter could be used for learning. He is training in cardiology and is aware that troponin (a protein measured to assess damage to the cardiac muscle) levels are often elevated in those with poor renal function. But seemingly this is still a hot topic, and is not acknowledged yet by labs or many doctors. So Christian tweeted an eminent cardiologist to see what he thought and got an ambivalent response. But the key was that it was ambivalent. He didn't just state that, 'No, there is no evidence that renal function is related to troponin levels', he hedged his bets.

Christian saw this as an illustration of how cardiologists could learn on Twitter. But I think it tells us a lot more about learning in the open. I am not a cardiologist. I'm a generalist. I don't diagnose NSTEMI ( a type of heart attack in which diagnosis is partly dependent on troponin levels) but I do manage little old ladies who are discharged on multiple medications after having NSTEMI diagnosed in hospital. So I was interested in this and through commenting on Christian's blog I was able to discuss this issue with him.

And of course patients and the wider public will also be able to gain insights into how many of the things which seem certain in medicine are perhaps not so certain. And that I hope can only be for the good.

I was just recovering from that clinical learning experience when I saw a medical student from Manchester tweet that she had found a tablet somewhere that she didn't recognise. Neil Mehta has done a great job of documenting the learning that came out of that episode on his blog, which you can read here.

There was a suggestion that the pink, oval tablet with EC stamped on it might be aspirin. Out of this rose a very interesting discussion with Jessica Ote, who is training as a family doctor. She asked if there was any evidence that taking NSAIDs (drugs like ibuprofen) with food helped to protect the stomach. I've saved our twitter discussion here using Keepstream, but unfortunately it doesn't embed well (you need greater customisation of embedding, Keepstream!), so you'll have to go to the site directly.

What these examples show is that social media allows us to document our clinical learning, and more importantly the questions we are asking, in the open. These questions don't have to remain in our heads. Next our networks can help us to answer these questions. And then the real benefit is that the learning is there in the open for everyone else to access. These networks can cross medicine (specialists and generalists), other professions (pharmacy, nursing, midwifery, OT), students and the patients and public.

We might even go and find the relevant wikipedia articles and decide to make them better!

PS Another great example of clinical learning in the open is Twitter Journal Club (#TwitJC) which starts tomorrow evening Sunday, 5th June.
And if you want a simple way to record your clinical learning that is happening in the open, have a look at TILT (Today I learned that...) from Jon Brassey, and the Tripdatabase team.

And I should point out that in the initial version of this post I stated that troponins were hormones. This was lazy. I was thinking of kinases (which are also measured to determine cardiac damage, but in any case are enzymes not hormones.) Christian kindly sent me a private message through Twitter pointing out that troponins are proteins, which along with actin and tropomyosin, are needed for cardiac muscle contraction. I've now corrected above (and added the wikipedia link so you can learn more) but I thought in the spirit of openness that I should document my mistake. Thanks Christian!

Digital professionalism... if only it were that easy

Image: Doctor reading articles by rosefirerising

The longer I am online and the more I become immersed in being online the more complex this existence seems.

I want to talk about some principles for "Digital Professionalism" which have been put forward by Rachel Ellaway in the journal Medical Teacher last year. The journal is paywalled so I am going to give the principles here.
The 7 principles are:

Principle #1: establish and sustain an on online professional presence that befits your responsibilities while representing your interests. Be selective in which channels and places you establish a profile.

Principle #2: use privacy controls to manage more personal aspects of your online profile and do not make anything public that you would not be comfortable defending as professionally appropriate in a court of law.

Principle #3: think carefully and critically about how what you say or do will be perceived by others and act with appropriate restraint in online communications.

Principle #4: think carefully and critically about how what you say or do reflects on others, both individuals and organizations, and act accordingly.

Principle #5: think carefully and critically about how what you say or do will be perceived in years to come; consider every action online as permanent.

Principle #6: be aware of the potential for attack or impersonation, and know how to protect your online reputation and what steps to take when it is under attack.

Principle #7: an online community is still a community and you are still a professional within it. The call for ‘is there a doctor. . .’ may come online as well as on a ‘plane or in a theatre’.

 To me these are good starting points, but as someone active in the space, I can see that these principles only take me so far. I'll write more in my next post but I wonder what you think of them now. Please comment.

Chatting on Twitter about Medical Education

Image: Coversations at Vermillion by JeanineAnderson

A few years ago when I started blogging and tweeting my aim was to try and connect with other people interested in medical education. It was hard to find people, and still the bulk of those involved in medical education- educators, students and doctors are not active in social media.

But there are enough of us here to make it reasonable to consider sketching out some spaces to interact and find each other. For the past year or so I've been pulling together people who are interested in medical education into a twitter list which you can find here.

There has also been talk over the last year or so about having a #meded chat. What is a tweetchat? It's a set time when people try to come together, usually over an hour, to discuss different topics which are usually agreed in advance. Medical education happens all over the world, so time zones (as well as language) become issues when trying to organise synchronous social media events.

In the US, Ryan Madanick is hosting the first #meded chat at 9pm EST or 1am UK time. Many of us will be in bed by then so we thought that it would be sensible to have a very informal chat at 9pm BST (8pm GMT) tonight about what the way forward might be for those of us in this timezone.

Personally, I think that tweetchats have quite a few limitations. Think of the limitations of twitter as a communication medium- 140 chts, unthreaded- and then square that for a tweetchat! They can seem noisy and confusing. So why bother? The main benefit is that you might get to know people who are interested in the same things as you, or who have different perspectives to you. You can decide to follow them on twitter, to visit their blog, to catch up on Skype, to meet up at a conference, or to write a paper together. The possibilities are endless, but essentially this is about networking.

If you want to join in the discussion just add #meded to your tweets between 9 and 10 pm tonight. I've tentatively started a google spreadsheet where we might enter topics that we want to discuss, but I'd be happy for us to discuss what way we want to run this tonight. Here is the spreadsheet.

Please feel free to leave any comments here, or just join in!